British researchers say that most people over 70 should think seriously about taking statins – because they are cost-effective and linked to better health outcomes, whether or not patients have a history of cardiovascular disease.
Heart disease and stroke are leading causes of death and disability globally, and as people age, the stroke and heart disease risk increases. Statins slash the risk by reducing levels of “bad” cholesterol – low-density lipids – in the blood and are widely used by middle-aged patients. However, reports The Guardian, they are less commonly taken by over-70s.
Borislava Mihaylova, an associate professor at Oxford Population Health and the lead author of the study, which was published in The BMJHeart, said: “Worldwide, many people suffer from preventable heart disease and stroke because of insufficient access to low-cost treatments like statins, yet improving access to the medication for older adults could improve their health.”
The research examined individual patient data from large-scale UK statin trials and predicted how statin therapy could influence their likelihood of developing heart disease, their health-related quality of life, and health-related care costs over their lifetimes.
The researchers then calculated the value of taking statins for more than 20 000 older people, with and without a history of CVD.
Taking statins, they found, significantly increased quality-adjusted life years, especially at higher intensity doses. Quality-adjusted life years is a measure used by the National Institute for Health and Clinical Excellence (NICE) to assess whether a treatment is worth providing on the NHS.
According to NICE, the threshold for good value treatment is less than £20 000 for each quality-adjusted life year gained.
The cost for each quality-adjusted life year gained was less than £3 500 for standard statins and below £12 000 for higher-intensity therapy – well below the NICE threshold.
For older people with no history of cardiovascular disease, the reductions in risk were substantially smaller.
The authors cautioned that this was an observational study, and as such, could not establish cause and effect.
Study details
Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study
Borislava Mihaylova, Runguo Wu, Junwen Zhou, Claire Williams et al.
Published in Heart in September 2024
Abstract
Background
Cardiovascular disease (CVD) risk increases with age. Statins reduce cardiovascular risk but their effects are less certain at older ages. We assessed the long-term effects and cost-effectiveness of statin therapy for older people in the contemporary UK population using a recent meta-analysis of randomised evidence of statin effects in older people and a new validated CVD model.
Methods
The performance of the CVD microsimulation model, developed using the Cholesterol Treatment Triallists’ Collaboration (CTTC) and UK Biobank cohort, was assessed among participants ≥70 years old at (re)surveys in UK Biobank and the Whitehall II studies. The model projected participants’ cardiovascular risks, survival, quality-adjusted life years (QALYs) and healthcare costs (2021 UK£) with and without lifetime standard (35%–45% low-density lipoprotein cholesterol reduction) or higher intensity (≥45% reduction) statin therapy. CTTC individual participant data and other meta-analyses informed statins’ effects on cardiovascular risks, incident diabetes, myopathy and rhabdomyolysis. Sensitivity of findings to smaller CVD risk reductions and to hypothetical further adverse effects with statins were assessed.
Results
In categories of men and women ≥70 years old without (15,019) and with (5,103) prior CVD, lifetime use of a standard statin increased QALYs by 0.24–0.70 and a higher intensity statin by a further 0.04–0.13 QALYs per person. Statin therapies were cost-effective with an incremental cost per QALY gained below £3502/QALY for standard and below £11778/QALY for higher intensity therapy and with high probability of being cost-effective. In sensitivity analyses, statins remained cost-effective although with larger uncertainty in cost-effectiveness among older people without prior CVD.
Conclusions
Based on current evidence for the effects of statin therapy and modelling analysis, statin therapy improved health outcomes cost-effectively for men and women ≥70 years old.
The Guardian article – Most people over 70 should consider taking statins, study finds (Open access)
See more from MedicalBrief archives:
Fewer people may need statins to prevent heart disease – US study
Benefits of statins may have been overstated – Irish meta-analysis
Large UK study finds statins fail to lower cholesterol in over half of patients